December 12, 2008

Outcomes of elective surgery in Chronic Type B Aortic Dissection

Girma Tefera, John Hoch, MD, Mathew Mell, MD, Charles Acher.
University of Wisconsin Medical School, Madison, WI, USA.

OBJECTIVES:To evaluate long term outcome following successful initial medical therapy for type B aortic dissection
METHODS: Records of patients treated for type B aortic dissection over 15 year period of time was recorded and analyzed. All patients had radiologically confirmed diagnosis and were admitted to vascular surgery service for initial intensive antihypertensive regimen consisting of Beta blockers and vasodilators. Patients who were successfully treated with the initial intensive medical therapy and discharged home were included in this study while those who required surgery within 15 days from onset of symptoms were excluded. Patients underwent elective surgical repair for aneurysm >/= 6 cm or rapid growth. Patient’s demographics, morbidity and mortality as well as factors associated with aneurismal dilation were analyzed. Kaplan-Meyer survival analysis was used to determine survival while t-test analyses were used to assess patient characteristics as a determinant of risk for need for surgical repair. P<0.05 achieved statistical significance.
RESULTS: Eighty three patients were identified of these, 79 were evaluated. Nineteen patients who required emergency surgery were excluded. The remaining 60 patients were successfully treated with intensive medical therapy and discharged home. At a mean follow up of 40 months, Eighteen patients developed aneurysms that required elective surgical repair, of these 15 (90%) occurred during the first year. Mean age was 65 years. Forty were male and thirty patients were smokers. Female gender was protective against further aneurismal dilation (p=0.0008). The 30 day mortality rate following initial medical therapy was 3.7%. Following elective surgery, the morbidity rate was 33% including one case of paraplegia. Thre was no mortality. Long term survival after elective surgery at 1, 3, and five years was 88%, 81% and 73%.
CONCLUSIONS:
Elective surgical therapy for chronic type B dissection can be performed with low morbidity and moratlity. Most (90%) occured during the first year. These results should be kept in mind when introducing endograft treatment modalities for chronic uncomplicated type B aortic dissections.

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